Section 03 · Monograph
Midodrine
Reviewed Nov 2026FDA label
ProAmatineAlpha-1 agonist
- Forms
- Tab: 2.5, 5, 10mg
- Dose
- 2.5-10mg TID daytime (last dose at least 4h before bed)
- MOA
- Peripheral vasoconstriction (orthostatic hTN)
Black Box Warning
- Can cause marked elevation of supine blood pressure; use only in patients whose lives are considerably impaired despite standard care, and continue only if clinical benefit is documented
Indications
- Symptomatic orthostatic hypotensionFDA-labeled
Mechanism of Action
- Prodrug converted to desglymidodrine, a selective alpha-1 agonist causing arteriolar and venous vasoconstriction and raising standing blood pressure
Full Dosing
Adult / usual
- Start 2.5mg three times daily; titrate (commonly up to 10mg TID) as tolerated
- Give during daytime upright hours — morning, midday and late afternoon; last dose at least 4 hours before bedtime
Renal
- Renal impairment: start at 2.5mg
Contraindications
- Severe organic heart disease
- Acute renal disease
- Urinary retention
- Pheochromocytoma or thyrotoxicosis
- Persistent and excessive supine hypertension
Drug Interactions
- Other vasoconstrictors: additive pressor effect
- Digoxin and beta-blockers: bradycardia and AV block
- Fludrocortisone: additive effect on supine hypertension
Adverse Effects
- Supine hypertension
- Piloerection (goosebumps), scalp pruritus or tingling
- Urinary retention
- Bradycardia
Monitoring Parameters
- Supine and standing blood pressure
- Urinary symptoms
- Renal function
Pregnancy & Lactation
- Limited data; use only if benefit justifies risk
- Unknown whether present in milk